Provider Demographics
NPI:1679712780
Name:FLORA I DANQUE MD INC
Entity Type:Organization
Organization Name:FLORA I DANQUE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:ISHIHARA
Authorized Official - Last Name:DANQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-441-1027
Mailing Address - Street 1:7918 EL CAJON BLVD
Mailing Address - Street 2:SUITE N322
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6719
Mailing Address - Country:US
Mailing Address - Phone:619-441-1027
Mailing Address - Fax:619-741-9422
Practice Address - Street 1:7918 EL CAJON BLVD
Practice Address - Street 2:SUITE N322
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6719
Practice Address - Country:US
Practice Address - Phone:619-441-1027
Practice Address - Fax:619-741-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62874261QP2300X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG18621Medicare UPIN